Separating truth from fiction in the presidential debates

by Robert I. Field, Ph.D., J.D., M.P.H.

Wednesday night's presidential debate felt at times like a walk through health care fantasyland.

Both candidates strayed from the confines of reality. However, some of Mitt Romney's pronouncements set a new standard for innovation in fact creation. (Click here for a transcript of the entire debate.)

Of course, no one expects perfect factual accuracy from political candidates. They are salespeople after all, and exaggeration is part of the job. But there's a line between that and outright falsehoods.

Let's start with President Obama. He claimed that health insurance premiums have risen more slowly over the past two years than at any time in the last 50. That's true for overall health care costs but not for premiums. And any implication that Obamacare caused the trend is highly suspect, because it hasn't yet fully gone into effect.

However, other than that, his health care statements were reasonably accurate.

Now let's turn to Governor Romney. Where should we start?

How about his claim that Obamacare includes a board that will tell people what treatments they can have? Could these be death panels by another name?

Obamacare includes no such board. The death panel rumor was thoroughly debunked before the law was even passed.

Romney didn't say what part of Obamacare he was referring to, so we can only guess where he dreamt this up. The law does include a panel that will recommend ways of limiting the growth of Medicare costs. But it is prohibited from even looking at actual treatments, and it makes no determinations concerning individual patients. And it has no authority to examine anything outside of Medicare.

Then there's the claim that Obamacare cut "$716 billion for current recipients of Medicare." The law makes no cuts for recipients or for anyone else. Obamacare does limit the growth of some payments to hospitals and managed care plans over time. However, in return, it substantially reduces the number of uninsured patients whom hospitals must treat for free. And it enhances some benefits, like coverage for drugs and preventive care.

Romney promised that if elected, he would "take that $716 billion you've cut and put it back into Medicare." That would be difficult, since nothing has actually been cut.

And apparently, he hasn't coordinated his position with his running mate. Rep. Paul Ryan (R – Wisc.) likes the Obamacare provisions on hospital and managed care payments so much that he included them in his budget proposal – not once but twice.

It would be interesting to hear Romney debate Ryan on this issue.

Another claim was that Obamacare would cause 20 million people to lose health insurance. Romney based it on a report by the Congressional Budget Office, but the report didn't say that. It estimated that between 3 and 5 million people might no longer be able to obtain coverage through their employers. However, most of them would be able to purchase individual policies through insurance exchanges.

And CBO also considered it possible that Obamacare would result in more employment coverage, not less.

Perhaps most misleading of all was the claim that Obamacare would "have the federal government take over health care." The government already funds over half of all American health care, with Medicare as the single biggest payer. Obamacare expands the federal role, but that role has been large and growing since Medicare was created almost 50 years ago.

Fact checkers have rightly called both candidates to task for exaggerations and misstatements. But few of the debate pronouncements bend reality as far as this.

At one point in the debate, Romney observed that with five boys, he's "used to people saying something that's not always true, but just keep on repeating it and ultimately hoping I'll believe it." Are these claims going to be repeated?